Cardiovascular events caused by dyslipidemia are one of the leading causes of death in patients with Chronic Kidney Disease (CKD). Statins are the first line of treatment for patients with hyperlipidemia and in the treatment regimen for patients with CKD. Therefore, the introduction of Proprotein Convertase Subtilisin-Kexin type 9 inhibitors (PCSK9 inhibitors) is a viable and possibly effective treatment option for patients who, despite high doses of statins, struggle to lower their low-density lipoprotein cholesterol (LDL-C) levels. Our paper's objective is to explore the safety of these biological agents, particularly in patients with varying stages of impaired kidney function, and the correlating effectiveness in lowering their LDL-C levels, thereby reducing cardiovascular risks in these patients.We methodically retrieved relevant articles from PubMed, PubMed Central, Medline, and Google scholar in April 2022. We used the Medical Subject Heading (MeSH) Strategy and used the relevant keyword, then applied our inclusion and exclusion criteria; the initial search gave 10,542 results; with the removal of duplicates, irrelevant articles, and application of quality assessments done, we finally included 15 papers for our review with 37,188 patients. PCSK9 inhibitors are reliable, safe, and efficient therapy in lowering LDL-C levels in patients with CKD. However, its safety and efficacy in severe and end-stage kidney disease are grey, as other factors such as infections lead to morbidity and mortality. Future trials on chronic kidney disease and PCSK9 inhibitors should investigate the inhibitors' ability to improve kidney functions at all stages of kidney disease while lowering lipid levels and finally analyze the safety in patients with end-stage kidney disease.

Gastroesophageal reflux disease (GERD) is a condition characterized by the reflux of stomach contents into the esophagus which leads to heartburn and regurgitation. GERD has been categorized its types according to severity. The categories that have been discussed in this study are reflux esophagitis (RE), non-erosive reflux disease (NERD), and Barrett's esophagus. Our study compared various studies and showed that the subjects with GERD had a high level of anxiety and depression. Gastroesophageal reflux disease has a significant negative impact on the quality of life (QoL) by perturbing daily activities. The majority of GERD patients use antacid drugs to control their acid symptoms. However, these symptoms are sometimes difficult to control, even with the most potent proton-pump inhibitors (PPIs) and these patients tend to have a lower response rate. According to the clinical data, Anxiety, and Depression are linked to the development of GERD. A major focus of this study is to explore psychological influences such as anxiety and depression, and how they relate to GERD. This study also reviews the effect of these conditions on the younger population. It is concluded that the QoL of subjects with GERD is reduced by depression and anxiety.

Alzheimer's, a neurodegenerative disease that starts slowly and worsens progressively, is the leading cause of dementia worldwide. Recent studies have linked the brain with the gut and its microbiota through the microbiota-gut-brain axis, opening the door for gut-modifying agents (e.g., prebiotics and probiotics) to influence our brain's cognitive function. This review aims to identify and summarize the effects of fecal microbiota transplantation (FMT) as a gut-microbiota-modifying agent on the progressive symptoms of Alzheimer's disease (AD). This systematic review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A systematic search was done using Google Scholar, PubMed, PubMed Central, and ScienceDirect databases in June 2022. The predefined criteria upon which the studies were selected are English language, past 10 years of narrative reviews, observational studies, case reports, and animal studies involving Alzheimer's subjects as no previous meta-analysis or systematic reviews were done on this subject.Later, a quality assessment was done using the available assessment tool based on each study type. The initial search generated 4,302 studies, yielding 13 studies to be included in the final selection: 1 cohort, 2 case reports, 2 animal studies, and 8 narrative reviews. Our results showed that FMT positively affected AD subjects (whether mice or humans). In humans, the FMT effect was measured by the Mini-Mental State Examination (MMSE), showing improvement in Alzheimer's symptoms of mood, memory, and cognition. However, randomized and nonrandomized clinical trials are essential for more conclusive results.

Non-alcoholic fatty liver disease (NAFLD) represents one of the leading causes of chronic liver disease globally, perhaps because of the drastic increase in prevalence around the world during the last 20 years and continues growing. The disease starts from simple steatosis (NAFL) that can progress to non-alcoholic steatohepatitis (NASH) and, in some patients, progress to cirrhosis and hepatocellular carcinoma (HCC). The pathogenesis and pathophysiology of NAFLD are complex and involve different factors (genetic, metabolic, endocrinopathies, and others). One of the concerns that appeared in recent years is hypothyroidisminduced NAFLD. The pathogenesis is compound and not well understood, and an association between hypothyroidism and NAFLD remains controversial because of insufficient studies that can confirm it. More research is needed to determine the association between hypothyroidism and NAFLD and the underlying mechanisms. In this review, we will discuss a more in-depth analysis of the physiology of thyroid hormones (TH) as well as the pathophysiology of hypothyroidism-induced NAFLD and, based on the recent metaanalyses, the association of thyroid hormones and NAFLD.

The objective of this systematic review and meta-analysis is to compare the postoperative outcomes of robotic and laparoscopic colorectal resection for colorectal malignancy. We performed a systematic review using a comprehensive search strategy on several electronic databases (PubMed, PubMed Central, Medline, and Google Scholar) in April 2022. Postoperative outcomes of robotic versus laparoscopic surgery for colorectal cancer were compared using 12 end points. Observational studies, randomized controlled trials, and nonrandomized clinical trials comparing robotic and laparoscopic resection for colorectal cancer were included. The statistical analysis was performed using the risk ratio (RR) for categorical variables and the standardized mean differences (SMD) for continuous variables. Sixteen studies involving 2,318 patients were included. The difference in length of hospital stay was significantly shorter with robotic access (SMD = -0.10, 95% CI = -0.19, -0.01, P = 0.04, I 2 = 0%). Regarding intra-abdominal abscesses, the analysis showed an advantage in favor of the robotic group, but the result was not statically significant (RR = 0.54, 95% CI = 0.28, 1.05, P = 0.07, I 2 = 0%). Mechanical obstruction was found to be higher in robotic group, favoring laparoscopic access, but was not significant (RR = 1.91, 95% CI = 0.95, 3.83, P = 0.07, I 2 = 0%). There was no difference in time to pass flatus and consume a soft diet. The rates of anastomotic leakage, ileus, wound infection, readmission, mortality, and incisional hernias were similar with both approaches. Robotic surgery for colorectal cancer is associated with a shorter hospital stay, with no differences in mortality and postoperative morbidity.